This prospective, multi-reader, randomized crossover trial evaluates SCOUT (Scalable Clinical Oversight via Uncertainty Triangulation), a model-agnostic meta-verification framework that selectively defers unreliable large language model (LLM) predictions to clinicians by triangulating three orthogonal uncertainty signals: model heterogeneity, stochastic inconsistency, and reasoning critique. The trial assesses whether SCOUT-assisted review can reduce physician review time compared with standard manual review of AI-generated diagnoses while maintaining non-inferior diagnostic accuracy in coronary heart disease (CHD) subtyping.
Board-certified or in-training cardiologists at Fuwai Hospital
Spanning three experience strata: junior residents, senior residents, attending physicians
Clinicians involved in the development or optimization of the SCOUT framework
Clinicians involved in the gold-standard adjudication process
Crossover
SCOUT-Assisted Review Workflow
Diagnostic testSCOUT-Assisted Review (Intervention Arm): Physicians review 56 cases processed through the SCOUT framework. For cases classified as low-uncertainty (D(x)=0), the AI prediction is auto-accepted without physician review. For high-uncertainty cases (D(x)=1), the physician reviews the case with access to the main model's chain-of-thought reasoning and the meta-verification audit results. The main model is DeepSeek-V3.1 with chain-of-thought prompting.
Standard Manual Review Workflow
Diagnostic testPhysicians perform a full manual review of 54 cases using raw medical records with access to the AI model's predictions and reasoning, but without SCOUT uncertainty stratification or selective deferral.
Mean physician review time per case (minutes)
Mean time spent by each clinician reviewing and rendering a diagnostic decision per case under each arm. Measured in minutes.
Diagnostic accuracy (%)
Proportion of correct CHD subtype classifications (STEMI, NSTEMI, unstable angina, chronic coronary syndromes) under each arm.
Computational Return on Investment (ROI)
Ratio of physician time savings (valued at standardized minute-wages from Sanming healthcare reform benchmarks) to computational cost of SCOUT inference, stratified by clinician seniority level.
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